1. Access to health data Ewout Kramer
Access to health data
Ewout Kramer
FHIR Core team (and software developer) Furore (Amsterdam, NL)
web:
ewoutkramer
skype:
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2. Common Nordic Architecture for Telemedicine
HL7 FHIR
Observation (CDG
2017 WAN-IF)
SOAP (Green CDA)
→ FHIR ?
Align to Continua TAN-IF, PAN-IF and LAN-IF
HL7 FHIR
Questionnaire (CDG WAN-IF) ?
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3. Personal Info Exchange
“In many ways this overlaps with the innovation framework labeled ‘SMART on FHIR’” 3
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4. REST AND DOCUMENTS
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5. Strong notion of inter-human “bulk transfer” (of data, responsibility)
Document-based data
“Here is the patient’s pregnancy file”
““Pass the DICOM metadata of last visit’s MRIs” “My training diary entries for today”
Strong notion of inter-human “bulk transfer” (of data, responsibility)
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6. Beware of the document Document based transfer is popular:
C-CDA in the US
XDS-based infrastructure on a national scale
Aligns with practitioner-to-practitioner human communication
But it does not fit every usecase! 6
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7. Longitudinal data
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8. Human/System interactions
Helse Vest Self booking Project
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9. (of events, facts, actions)
Request/Response
“I’d like to reschedule my appointment”
“Which medication is the patient
using?”
“Your new lab results are ready”
Strong notion of fine-grained app-to- server “communication”
(of events, facts, actions)
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10. Warning!
“The problem with this approach is that the CDA is really only a container for the information.”
“The recent introduction of FHIR by HL7 is in JASON’s view a significant improvement over CDA. FHIR attempts to standardize the exchange of information through a set of modular components that are called Resources”
“Data for Individual Health” – US JASON Taskforce, November 2014
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11. What about XDS in the Nordic countries?
SE: (…) As a result, there is no national EHR database, nor is there a demand for a document exchange infrastructure
NO: A possible future migration to XDS-based document exchange is being considered.
DK: The future for clinical exchange (…) is basically based on XDS based document exchange.
Source: Towards a Nordic Reference Architecture for Personal Connected health and care Technology
Lars Kristian Roland, Architect at the Norwegian Directorate of eHealth; Johan Eltes, Deputy CTO Inera AB, Thor Schliemann, Architect at the Danish Health Data Authority. 11
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12. Integrating in the EMR SMART ON FHIR12
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13. Objective In early 2010, Harvard Medical School and Boston Children’s Hospital began an interoperability project with the distinctive goal of developing a platform to enable medical applications to be written once and run unmodified across different healthcare IT systems. The project was called Substitutable Medical Applications and Reusable Technologies (SMART).
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14. Motivation…. Turn bright ideas into real apps Take away the technolog
y burdens 14
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15. Why ? App choice (substitutability) for users
Low barriers to entry for developers
Apps can run in systems by different vendors
Apps can run in different contexts (e.g. EHR and Patient Portal)
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16. SMART The App Platform for Healthcare
Standard formats and protocols for healthcare data
Open source development tools and resources
Public gallery to connect apps and users
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17. SMART = FHIR + … 17
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18. SMART Authorization Based on OAuth2 standard Two launch workflows
EHR/Portal Launch – user picks an app from within EHR (EHR can pass along context like encounter and patient)
Standalone Launch – user launches app and picks an EHR server (can run from mobile devices)
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19. SMART Authorization
Slightly simplified - details at:
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20. Agree on actual codes
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21. Additional constraints
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22. App Gallery
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23. Growth analyzer 23
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24. Run a demo…
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25. Launch context
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26. © 2014 HL7 ® International. Licensed under Creative Commons
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27. © 2014 HL7 ® International. Licensed under Creative Commons
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28. CDS-Hooks EMR Events in the EMR External services hooked to the events
Medication- prescribe
Order-review
Patient-view 28
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29. Source: https://github.com/cds-hooks/cds-hooks/wiki
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30. Live demo
Try:
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31. Uses for CDS hooks
Opening patient record prompts action in trial selection system
Placing a medication order prompts (pricing/interaction) guidance in EHR
Placing a medication order returns medication info in foreign language of patient
Opening a patient adds links to apps with detailed genomic results
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32. Common theme
SMART and CDS-hooks open up the EMR as a platforms in which 3rd-parties can become part of the workflow
3rd party suppliers can provide more specialized functionality than an EMR would every implement 32
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33. Argonaut Project Initiative to get FHIR and SMART ready for broad use
by testing standards with widely adopted EHR systems
Founding organizations:
EHR Vendors:
athenahealth, Cerner, Epic, McKesson, MEDITECH, Surescripts
Healthcare Organizations and Companies:
Beth Israel Deaconess Medical Center, Intermountain Health, Mayo Clinic, Partners Healthcare System, SMART at Boston Children’s Hospital Informatics Program, The Advisory Board Company, Accenture
Implementation program – free to participate
20+ vendors
Series of development sprints
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34. FHIR QUESTIONNAIRES 34
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35. What is Questionnaire for?
Questionnaires are a typical means for capturing information from humans
Both within and outside of healthcare
Provide great control over data capture
What data is requested
How question is phrased
Constraints on allowed responses
In what order questions are presented
Under what circumstances information is needed
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36. Item-group Item/question Nested Item/question 36
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37. Questionnaire(Response)
Questionnaire: The “Definition” of the content to be captured
What questions(items) are to be asked when and how?
QuestionnaireResponse: A completed (or partially) completed instance of a Qnnaire
There may be hundreds (or thousands) of QuestionnaireResponses for one Questionnaire
QuestionnaireResponses can exist without a Questionnaire at all (paper, legacy)
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38. Questionnaire model Nests! Linkid: ties questionnaire and response
Required: yes/no Repeats: yes/no
status: Is this questionnaire still active? date: When did this status become effective subjectType: What must
QuestionnaireResponse.subject be? concept: Code for the overall questionnaire
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39. Item types There are 3 main types of items in a questionnaire:
display – Cannot have an answer or nested items
– just text for display
group – Cannot have an answer and must have nested groups and/or questions
question (abstract) – Can have an answer, but may also have nested items
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40. QuestionnaireResponse
Here’s linkId again!
Author, source and subject!
Answer can point to a real Resource!
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41. Example Questionnaire / Response workflow
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42. Standard FHIR services
Questionnaire/$populate
Generate a QuestionnaireResponse for a specified Questionnaire, optionally filling in data from a local or submitted data
Requires business logic in server to know “how” to populate
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43. Usage Forms in apps US ‘Structured Data Capture’ (SDC) project
Pre-population of forms from CDA R2 data
re+Initiative
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44. Render-a-Questionnaireh
ttp://smartq.azurewebsites.net/Home/Sel
urvey
ect S
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45. C3-PRO + ResearchKit Source: http://c3-pro.chip.org/architecture.html
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46. Caveat There is overlap between Questionnaires and other Resources
Questionnaire's flexible structure can easily be misused to capture any data
Choice between Questionnaires or Resources may be dictated by the procedure of collection and recording
46  No binary choice!
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47. DEVICE OBSERVATION – A PROFILE47
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48. The Observation
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49. Points of Interest Subject: the Patient and/or the Device
effective[x] and issued
Component versus Related
Device and DeviceMetric
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50. Example instance
2?_format=xml
satO2.html
Take a look at the xml!
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51. Continua WAN Uses IEEE 11073 and IHE-PCD Profile
Semantically equivalent to
FHIR DeviceMetricObservation profile
(FHIR will be used in 2017 CDG WAN-IF?)
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52. IEEE 11073 in FHIR DeviceComponent Resource
(any medical device that does not represent a metric, e.g. MDS, VMD, or Channel)
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53. IEEE 11073 in FHIR DeviceMetric Resource
(mandatory static properties that characterize a direct or derived, quantitative or qualitative biosignal measurement, setting, or calculation produced by a medical device)
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54. DeviceMetric Observation
Constrained version of Observation
Subject: only Patient or Device
No: Encounter link, “issued”, “dataAbsentReason”, specimen
Mandatory: effectiveDateTime (not Period)
Mandatory link to DeviceMetric (not to Device)
15x “Must Support”
Let’s try this in Forge
Define SpO2 DeviceMetricObservation…
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55. PATIENT ACCESS OR PATIENT IN THE CENTER?55
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56. Your “Mobile” device becomes the Big Aggregator and Coordinator of data and functionality
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57. In the financial sector…57
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58. Apple ResearchKit 59
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59. Where is the Portal? PHR?
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60. Reality?
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61. Reality?
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62. FINALLY… 63
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63. Tutorials Networking Connectathon FHIR experts and authors on hand
All the latest information on FHIR
Networking
FHIR experts and authors on hand
Connectathon
Meet fellow developers
Put FHIR to the test 64
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